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NPI Code Detail

MEDICARE: 101 BEHAVIORAL PLLC

MEDICARE: 101 BEHAVIORAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1356299119
Entity Type Code : Organization
Provider Name (Legal Business Name) : 101 BEHAVIORAL PLLC
Provider Business Mailing Address
First Line : 101 N CREST PL
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-2984
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 CLINTON ST
Second Line :
City : CARLYLE
State : IL
Zip : 62231-1503
Country : US
Telephone Number : 732-552-5087
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. YAACOV WEISS
Credential : LCSW
Telephone Number : 732-552-5087
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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